Cutting Seton for the Treatment of Cryptoglandular Fistula-in-ano: a Systematic Review and Meta-Analysis

J. Khamar,A. Sachdeva,T. McKechnie,Y. Lee, L. Tessier,D. Hong,C. Eskicioglu

Techniques in coloproctology（2023）

McMaster University | University of Toronto

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Abstract

The use of cutting seton (CS) for the management of cryptoglandular fistula-in-ano has remained controversial because of reports of fecal incontinence, postoperative pain, and extended healing time. The aim of this review was to provide the first synthesis of studies investigating the use of CS for the treatment of cryptoglandular fistula-in-ano. MEDLINE, Embase, and CENTRAL were searched up to October 2022. Randomized controlled trials and observational studies comparing CS with alternative interventions were included, along with single-arm studies evaluating CS alone. The primary outcome was fistula-in-ano recurrence, and secondary outcomes included incontinence, healing time, proportion with complete healing, and postoperative pain. Inverse variance random-effects meta-analyses were used to pool effect estimates. After screening 661 citations, 29 studies were included. Overall, 1513 patients undergoing CS (18.8

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Key words

Cutting seton,Fistula-in-ano,Anorectal fistula,Cryptoglandular fistula,Colorectal surgery

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